Types of Essential Hypertension and their Relationship to Therapy*
STATISTICS1 show that more than 500,000 persons in this country die each year as a result of hypertensive vascular disease. It has been estimated that hypertension affects 20 to 40 per cent of the population.2,3 This implies that there is no consistently effective therapy for high blood pressure in spite of the numerous reports of medications, dietary schedules and surgical procedures, each of which is reported to give good results in 50 to 85 per cent of patients. In 1929 Ayman4 listed 200 separate remedies which had been recommended during the preceding decade. The table lists 8 widely diverse treatments offered in the past twenty-five years. The favorable results reported are comparable. A rational explanation of why psychotherapy, oral ingestion of thiocyanates, restriction of dietary sodium and operations upon the sympathetic nervous system should exact similar physiological responses is obscure. The only obvious possibility is that some hypertensive persons respond to attention and care in the same way regardless of “specific” treatment. If this is the correct interpretation all statistics will be difficult to construe unless this factor can be eliminated.
Differentiation of known causes of hypertension is important. From the great pool of patients formerly classified as essential hypertensives, one is now able to delineate properly, prognosticate accurately and treat better such widely diverse pathologic states as pheochromocytoma, Cushing’s syndrome, adrenogenital syndrome, coarctation of the aorta, polycystic kidney disease, chronic glomerulonephritis, unilateral kidney disease, and polycythemia vera. Before separation of each of these into proper niches, one factor was. . .